Don't blame doctors!

JMDA president says medical staff overworked and overburdened’

PRESIDENT of the Jamaica Medical Doctors Association (JMDA) Dr Alfred Dawes said yesterday that doctors should not be blamed for the death of 34-year-old Jason Forbes at the Spanish Town Hospital, St Catherine on Wednesday.

"... If you're going to blame anybody, don't just single out doctors and blame doctors, blame the infrastructure, blame the lack of adequate staffing, and blame the patients who are crowding up the emergency room unnecessarily," Dr Dawes told the Jamaica Observer yesterday.

Forbes' sister, Carmen Gunn, told the Jamaica Observer on Wednesday that her brother went to the hospital some time after 7:00 pm on Tuesday, complaining about a pain in his stomach. However, it was not until more than 14 hours later, on Wednesday morning, that his name was eventually called, but by then, Gunn said her brother was dead.

Dr Dawes, who was on duty at the health facility on Tuesday night, attempted to shed some light on the situation yesterday.

"I worked in surgery but we never got that referral," eh said. "The patient, as you rightly said, was never assessed by the emergency team until he had collapsed."

Dr Dawes said the population in St Catherine has tripled since 1972 and that since then, very little improvement has been made to the hospital.

"We have seen an influx of patients, an increased caseload since the removal of user fees, patients in general prefer to come to the hospital since they are not paying anything and because they perceive that it is better care that they are getting than at the health centres," Dr Dawes told the Observer. "So we are overwhelmed with patients who are non-urgent, who can be seen at health centres."

Dr Dawes, a general surgeon, explained that the triage system is used to determine the priority of patients' treatment, which is dependent on the severity of their conditions.

"The triage system operates in such that emergency patients and somebody who has trauma, somebody who has chest pain, somebody with a head injury that's severe, would be priorities," he said.. "The urgent cases are those with the abdominal pain, like this gentleman, and those who have some other cuts, other signs of trauma that can be seen, not on an emergency basis as the first-come-first-serve, but, to put it simply, first-come-second-serve.

"These patients are then followed by non-urgent cases which are those with "fever, rashes, coughs, cold, and people who are abusing the system coming in with their STIs (sexually transmitted infections) and so forth. So, what happened was that there was an influx of emergencies and those kept bumping the urgent cases back so that the doctors on duty in accident and emergency never got a chance to move through the urgent cases as quickly as they would've liked to...," Dr Dawes explained.

He said this was the reason Forbes, with his abdominal pain, "was sitting there with dozens of other people with abdominal pain and we couldn't sift through". By sifting through the doctors would then make a clinical judgement to see who was really an emergency case to get them into the emergency area for urgent attention, Dr Dawes added.

"That was not the case with this gentleman because he walked in several hours before, he was not that ill at that time, he deteriorated overnight, unfortunately, but he was never seen on time because we were pretty much overwhelmed," said Dr Dawes.

The JMDA president also insisted that Forbes' death was not the doctors' fault.

"It is pretty much the staffing that was very poor, it is not that the doctors were callous, inconsiderate or made errors in judgement," said he said. "It's just that we could not go through emergencies in a quick enough time to get to the (urgent cases)."

He pointed out that the issue of staffing is nothing new but that it was further compounded by the number of patients who turn up at hospitals instead of seeking medical attention at health centres.

He told the Observer that there was an urgent need to "improve the staffing throughout the health care sector [as] we are overworked and overburdened and we need to educate the public that the health centres are adequately equipped to deal with non-urgent conditions and that is the only way we are going to get persons who really need emergency and urgent medical attention being attended to in a timely manner".

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